Diagnosis and treatment of patellofemoral joint arthritis

Although patellofemoral arthritis is a common and debilitating orthopedic disorder, its treatment varies and remains controversial. This review aims to provide an overview of the current understanding of the pathophysiology of patellofemoral arthritis, as well as its various diagnostic and treatment options.Current Concepts: The pathophysiology of patellofemoral arthritis includes lower limb malalignment, trochlear and/or patellar dysplasia, patellar instability, trauma, and obesity. The disorder is characterized by chronic anterior knee pain aggravated by flexion of the knee joint. A critical imaging study of the Merchant and lateral knee radiographs may show the progression of patellofemoral arthritis and dysplasia of the patellofemoral joints. Non-pharmacologic treatment options for patellofemoral arthritis include patient education, self-management, exercise, weight loss, taping, bracing, and orthotics. Pharmacologic agents (non-steroidal anti-inflammatory drugs, acetaminophen, oral narcotics, and duloxetine) and intra-articular injection therapies (glucocorticoids, hyaluronic acid, platelet-rich plasma, and other regenerative therapies) can be helpful for symptom relief in patients with patellofemoral arthritis. The surgical treatment can begin with lateral retinacular release to realign and decompress the patellofemoral joint. If failure in the improvement of symptoms is noted, a tibial tubercle osteotomy can be considered in young and active patients. While the early design and technique of patellofemoral arthroplasty were less than encouraging, more recent implant design and surgical techniques have demonstrated robust results.Discussion and Conclusion: Patellofemoral arthritis is a unique entity compared with tibiofemoral arthritis marked by distinct epidemiology, biomechanics, and risk factors and treatment options. It is essential to understand its pathophysiology and ensure proper treatment options.

A Deep Learning Model with High Standalone Performance for Diagnosis of Unruptured Intracranial Aneurysm

Purpose@#This study aimed to investigate whether a deep learning model for automated detection of unruptured intracranial aneurysms on time-of-flight (TOF) magnetic resonance angiography (MRA) can achieve a target diagnostic performance comparable to that of human radiologists for approval from the Korean Ministry of Food and Drug Safety as an artificial intelligence-applied software. @*Materials and Methods@#In this single-center, retrospective, confirmatory clinical trial, the diagnostic performance of the model was evaluated in a predetermined test set. After sample size estimation, the test set consisted of 135 aneurysm-containing examinations with 168 intracranial aneurysms and 197 aneurysm-free examinations. The target sensitivity and specificity were set as 87% and 92%, respectively. The patient-wise sensitivity and specificity of the model were analyzed. Moreover, the lesion-wise sensitivity and false-positive detection rate per case were also investigated. @*Results@#The sensitivity and specificity of the model were 91.11% [95% confidence interval (CI): 84.99, 95.32] and 93.91% (95% CI:89.60, 96.81), respectively, which met the target performance values. The lesion-wise sensitivity was 92.26%. The overall falsepositive detection rate per case was 0.123. Of the 168 aneurysms, 13 aneurysms from 12 examinations were missed by the model. @*Conclusion@#The present deep learning model for automated detection of unruptured intracranial aneurysms on TOF MRA achieved the target diagnostic performance comparable to that of human radiologists. With high standalone performance, this model may be useful for accurate and efficient diagnosis of intracranial aneurysm.

A Deep Learning Model with High Standalone Performance for Diagnosis of Unruptured Intracranial Aneurysm

Purpose@#This study aimed to investigate whether a deep learning model for automated detection of unruptured intracranial aneurysms on time-of-flight (TOF) magnetic resonance angiography (MRA) can achieve a target diagnostic performance comparable to that of human radiologists for approval from the Korean Ministry of Food and Drug Safety as an artificial intelligence-applied software. @*Materials and Methods@#In this single-center, retrospective, confirmatory clinical trial, the diagnostic performance of the model was evaluated in a predetermined test set. After sample size estimation, the test set consisted of 135 aneurysm-containing examinations with 168 intracranial aneurysms and 197 aneurysm-free examinations. The target sensitivity and specificity were set as 87% and 92%, respectively. The patient-wise sensitivity and specificity of the model were analyzed. Moreover, the lesion-wise sensitivity and false-positive detection rate per case were also investigated. @*Results@#The sensitivity and specificity of the model were 91.11% [95% confidence interval (CI): 84.99, 95.32] and 93.91% (95% CI:89.60, 96.81), respectively, which met the target performance values. The lesion-wise sensitivity was 92.26%. The overall falsepositive detection rate per case was 0.123. Of the 168 aneurysms, 13 aneurysms from 12 examinations were missed by the model. @*Conclusion@#The present deep learning model for automated detection of unruptured intracranial aneurysms on TOF MRA achieved the target diagnostic performance comparable to that of human radiologists. With high standalone performance, this model may be useful for accurate and efficient diagnosis of intracranial aneurysm.

The Association between CD14 Polymorphism and Response to Infectious Agents or Heat Shock Protein in Patients with Stable Coronary Artery Disease in Koreans

BACKGROUND: CD14 is the receptor for lipopolysaccharides and heat shock protein (HSP), which has been suggested being associated with increased risk of coronary artery disease (CAD). We investigated whether the response to infectious agents or HSP is different according to CD14 polymorphism in Koreans. MATERIALS AND METHODS: Antibody titers to Helicobacter pylori, Chlamydia pneumoniae, and human HSP60 (hHSP60) were measured in 48 patients with stable CAD and in 41 healthy controls by ELISA. CD14 genotype was determined by PCR and high-sensitivity C-reactive protein (hs-CRP) was measured. RESULTS: Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly associated with the presence of CAD. CD14 genotype distribution was 31 TT (35%), 43 CT (48%), and 15 CC (17%). To compare the response to the infectious organism and hHSP60, we divided study population into 3 groups; CAD patients with non-TT genotype (group I, n=30), CAD patients with TT genotype (group II, n=18), and normal controls (group III, n=41). Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly different among 3 groups. Though hs-CRP level was significantly different among 3 groups, post-Hoc analysis showed that hs-CRP level was not significantly different between group I and group II (group I: 1.6[1.1-3.5] mg/L and group II: 0.35[0.1-2.0] mg/L). Conclusions:This study suggests that the inflammatory responses to infectious organisms and HSP do not differ according to the CD14 genotype in Koreans.

The Association between CD14 Polymorphism and Response to Infectious Agents or Heat Shock Protein in Patients with Stable Coronary Artery Disease in Koreans

BACKGROUND: CD14 is the receptor for lipopolysaccharides and heat shock protein (HSP), which has been suggested being associated with increased risk of coronary artery disease (CAD). We investigated whether the response to infectious agents or HSP is different according to CD14 polymorphism in Koreans. MATERIALS AND METHODS: Antibody titers to Helicobacter pylori, Chlamydia pneumoniae, and human HSP60 (hHSP60) were measured in 48 patients with stable CAD and in 41 healthy controls by ELISA. CD14 genotype was determined by PCR and high-sensitivity C-reactive protein (hs-CRP) was measured. RESULTS: Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly associated with the presence of CAD. CD14 genotype distribution was 31 TT (35%), 43 CT (48%), and 15 CC (17%). To compare the response to the infectious organism and hHSP60, we divided study population into 3 groups; CAD patients with non-TT genotype (group I, n=30), CAD patients with TT genotype (group II, n=18), and normal controls (group III, n=41). Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly different among 3 groups. Though hs-CRP level was significantly different among 3 groups, post-Hoc analysis showed that hs-CRP level was not significantly different between group I and group II (group I: 1.6[1.1-3.5] mg/L and group II: 0.35[0.1-2.0] mg/L). Conclusions:This study suggests that the inflammatory responses to infectious organisms and HSP do not differ according to the CD14 genotype in Koreans.